[Clinical insignificance of prostate cancer: are there morphological findings?].
OBJECTIVE
Overdiagnosis and overtreatment of microfocal nonpalpable and early-stage prostatic adenocarcinoma are currently a topic of strong discussion. We tried to find morphological findings of such insignificant carcinomas of the prostate.


METHODS
More than 1,000 consecutive core needle biopsy specimens of prostate carcinoma taken during 1 year (2007) were graded according to the modified Gleason scoring system. The results were correlated to serum prostate-specific antigen (PSA) and tumor extent in the cores.


RESULTS
Cases with PSA <10 ng/ml and tumor extent <20% frequently (up to 55%) had Gleason scores of 6 or 7a. Cases with PSA >10 ng/ml or tumor extent >20% had higher Gleason scores (>7a). Cancers with tumor infiltration of <1 mm in one of up to 12 cores and PSA <10 ng/ml mainly had low Gleason scores (6 and 7a), but only 5% of the carcinomas in the studied specimens corresponded to such a parameter. Only 25% of such patients had a pT2a tumor after radical prostatectomy.


CONCLUSIONS
With a very restricted parameter of a microfocal adenocarcinoma of the prostate with a Gleason score <7a, tumor infiltration of <or=1 mm in only one core needle biopsy, and PSA of <or=10 ng/ml, clinical insignificance may be possible, and in agreement with the patient, active surveillance is feasible. However, such cases are rare.
Helpap
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Schwerpunkt Uropathologie, Institut für Pathologie, Singen, Deutschland. burkhard.helpap@hbh-kliniken.de
Egevad
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D000328:Adult; D000368:Aged; D001707:Biopsy, Needle / Q000379:methods*; D006801:Humans; D008297:Male; D008875:Middle Aged; D017430:Prostate-Specific Antigen / Q000097:blood*; D011471:Prostatic Neoplasms / Q000097:blood* / Q000175:diagnosis*; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity
D017430:Prostate-Specific Antigen